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TRADITIONAL PRINCIPLES Medical care has been a matter of individual responsibility of both the patient who seeks the care and the doctor who administers it. This historical principle of medical economy as practiced in our country has produced the highest quality of medical care more generally available than in any other nation in the world today or in history.

Those governments who, in recent years, assumed the obligation to provide medical care for its citizens have, as a result, diminished the quality, increased the cost, and thwarted medical progress in comparison to the achievements of medical care in the United States provided under the principle of bilateral individual responsibility.

Traditionally, the individual physician has assumed the obligation to provide medical care to those who request his services regardless of their ability to pay. Fulfillment of this responsibility depends upon the physician's abilities and limitations of the environment. As the need for hospital facilities to provide good modern medical care for serious illness has increased, it has become more difficult for the individual physician, especially in the urban environment, to provide medical care for those unable to pay the costs of the facilities, medications and services required. Local and State governments in a variety of manners have assumed some of these costs for the indigent sick. More recently, by amendments to the social security law, the Federal Government has sought to standardize medical care for the indigent as a function of the department of welfare and assume the bilateral responsibility of medical care for these citizens through the medium of Federal-State matched payments to "vendors" of medical services to public assistance recipients.

The proposed legislation under consideration, H.R. 4700, would assume for the Federal Government the responsibility of providing medical services for a segment of the population without the requirement of indigence. With only a change in age limits the entire population would be relieved of this vital individual responsibility and the services of the medical profession would be a part of the Government welfare program.

Thus a program of Government medical care would be achieved with little promise of providing a better quality or less costly medical care for the people of this country. Admittedly, the bookkeeping would be streamlined, but at what . cost in individual liberty inevitably lost when responsibility is surrendered. Can a government founded on the sovereignty of the people afford so great a loss of individual responsibility which is the foundation of sovereignty?

Laws and regulations must not be created that will thwart exercise of the fundamental American medical economic principle of bilateral responsibility for medical care in solving today's health problems as they have so successfully achieved major medical advances in the past.

The commerce and institutions developed in the solution of today's health problems by voluntary health insurance and medically directed indigent care programs would strengthen the economy and our most vital national resource, the initiative of individual responsibility. Government financed welfare directed free medical care programs will tax our economy and weaken the sovereign power of the people.

The CHAIRMAN. Dr. Hampton, we thank you, sir, for bringing to us the views of the Florida Medical Association on this legislation. You have presented your case in a very fine manner. You have made a good witness.

Dr. HAMPTON. Thank you, sir.
The CHAIRMAN. Mr. Mason?

Mr. Mason. All I want to say, Dr. Hampton, is this: You are the second physician today who has been telling us what your tSate is doing toward the solution of this problem, and that is the American way.

Mr. HERLONG. Will the gentleman yield at that point?
The CHAIRMAN. Mr. Herlong.

Mr. HERLONG. I would like to stress a statement that the doctor made that no one in Florida is denied hospital care that needs it.

The CHAIRMAN. Thank you again, Doctor.
Dr. HAMPTON. Thank

you. I would like to say, if I may, that I was impressed by Mr. Alger's comments this morning about catastrophic or major medical insurance. I believe that is the answer as he pointed out this morning.

This thing of preventing the abuses to any type of insurance policy whether it is voluntary, whether it is commercial, or whether it is Government, is the key because, if the patient stays in the hospital one more day on an average, that is where the costs go up and the doctors are practically the only people who can prevent those abuses and they must be encouraged to assume that responsibility rather than letting that initiative and responsibility atrophy by Government paternal assumption.

The CHAIRMAN. Thank you, sir.
Dr. HAMPTON. Thank you, sir.
Mr. ALGER. Mr. Chairman.
The CHAIRMAN. Mr. Alger.

We have a rule around here that when you refer to a member, he is expected to pick up at that point and say something in his own defense, so we will have to recognize Mr. Alger.

Mr. ALGER. Mr. Chairman, I do not think we always wait to be recognized in that circumstance.

Dr. Hampton, you make the point, if I get it, that there are two groups of individuals that do need help and you are not contesting that, first, people on the welfare rolls who cannot take care of themselves; secondly, the medical indigent, and Florida law, as brought out under questions by the gentleman from Florida, is moving to help these two groups of people who have the difficulty and you are doing this without asking an overall, all-inclusive Federal program.

Dr. HAMPTON. That is true, sir.

Mr. ALGER. You made another statement on page 5 that I want to compliment you on because you pointed out that the medical care quality we have in this Nation is greater than in any other nation in the world today. This has occurred, if you please, without the type of compulsory Federal legislation now being asked for.

Secondly, you make another statement here which supports what the gentleman from Florida said earlier, quoting from page 5:

Traditionally, the individual physician has assumed the obligation to provide medical care to those who request his services regardless of their ability to pay.

Over and over we are hearing from the doctors, unless they are falsifying before this committee, that people who need the medical care are getting it, and those who are proponents of this bill and who think we also ought to have compulsory legislation are not proving their case that the people are not getting medical care.

I hope that you will follow these hearings because I asked Mr. Cruikshank this morning if he would submit a list of the record of cases where people are being turned away and, if there is any legitimate statement which he makes in that regard, I hope that you folks will be prepared in turn to answer Mr. Cruikshank.

Dr. HAMPTON. Thank you, sir. We invited the inspection.

Mr. ALGER. I did ask that the record be left open and that was granted.

If the AMA would add further light to this, I would appreciate it.
The CHAIRMAN. That permission has already been granted.
Thank you again, sir.
Our next witness is Dr. Irving.

Dr. Irving, the Chair observes our colleague from Iowa, the Honorable Ben Jensen, who is present. Mr. Jensen, would you like to introduce these gentlemen ? STATEMENT OF REPRESENTATIVE BEN F. JENSEN, OF IOWA Mr. JENSEN. I would be pleased and honored to do that, Mr. Chairman.

Mr. Chairman and members of the committee, I would like to introduce two very eminent doctors of Iowa. I have learned to respect the doctors of Iowa and the doctors of America. These doctors are very modest people. They cover their light under a bushel.

The doctors of Des Moines, Iowa, I have learned, do many operations and serve a lot of old people for exactly nothing. It warms my heart to know such people.

We are proud of these doctors of ours in the State of Iowa and I am sure they are a fair example of the doctors of this Nation.

First, I want to introduce Dr. Irving, who is chairman of the Legislative Committee for the Medical Society of Iowa, and next Dr. Wichern, who is the cochairman of the Legislative Committee of the Iowa State Medical Society. Dr. Irving will speak first, Mr. Chairman.

The CHAIRMAN. Dr. Irving, you live in Des Moines, do you? STATEMENT OF DR. NOBLE W. IRVING, CHAIRMAN, IOWA STATE MEDICAL SOCIETY'S COMMITTEE ON LEGISLATION; ACCOMPANIED BY DR. HOMER E. WICHERN, COCHAIRMAN Dr. IRVING. Yes, sir. The CHAIRMAN. Dr. Wichern, you live in Des Moines? Dr. WICHERN. Yes, sir. The CHAIRMAN. You are going to make the statement, are you Dr. Irving!

Dr. IRVING. Yes. The CHAIRMAN. I notice we have you limited to 5 minutes. You are recognized for 5 minutes. Dr. IRVING. Thank you, sir, and members of the committee. Honorable chairman and members of the committee, I am Dr. Noble W. Irving, of Des Moines, Iowa, where I am engaged in the private practice of medicine. I am chairman of the Iowa State Medical Society's Committee on Legislation, in which capacity I am appearing. Accompanying me is Dr. Homer E. Wichern, also of Des Moines, and in private practice. He is cochairman of our committee.

I wish to thank your committee for the opportunity and privilege of appearing before it on behalf of the Iowa State Medical Society and in behalf of the 2,500 Iowa doctors of medicine to discuss H.R. 4700, introduced by Hon. Aime J. Forand, of Rhode Island.

Iowa physicians have reached a degree of unanimity seldom attained in: First, proposing and carrying out a positive plan of action

for improving voluntary ways and means of financing health care for our senior citizens; and secondly, in opposing H.R. 4700.

Our society some 3 years ago intensified its studies toward solving some of the medico-economic problems of the aged. The Iowa State Medical Society, cooperating with the Iowa Hospital Association, Iowa Dental Association, and Iowa Nursing Home Association, established the Iowa Joint Council for Care of the Aged—one of the first, if not the first, such State groups to be organized. Its purpose is to determine the extent to which health care problems of asl types exist in Iowa and to recommend remedial measures.

The Iowa State Medical Society's Blue Shield plan was the first in the Nation to place a special, low-cost senior 65" plan on the market at a rate within the ability of nearly all except the indigent to pay. It has met with an excellent public response. The same is true for the Iowa Hospital Association's Blue Cross plan sold concurrently. At least two large, private insurance companies have chosen Iowa within the past 2 years to introduce policies for the aged and others are entering this field on an accelerated basis.

Iowa doctors are assuming that this committee, proponents, and opponents of H.R. 4700, all sincerely want the same thing: the best medical care for our senior citizens, together with all others. We earnestly thank Mr. Forand for focusing attention on this matter of health care for the aged at the national level and in Iowa, which has one of the highest percentages of people 65 or over in the Nation.

However, Iowa doctors feel the approach inherent in H.R. 4700 toward solving the various problems through the medium of further expansion of social security into this field is seriously in error because:

i. Any problem that can be met voluntarily by private enterprise should not be entered by Government.

2. It would interpose the Government between the patient and the doctor.

3. The vast majority of Iowa doctors are convinced that the timetested practice of medicine on a voluntary basis provides the best possible care for any segment of our population. So firmly convinced are they of this fact, that they are underwriting, where needed, more than half the cost of their services.

4. It is unnecessary. Accelerating forces are at work that will reduce substantially the number of retired persons supposedly requiring subsidization by Government. More and more insurance companies in Iowa are following the lead of the Blue plans in allowing policyholders to retain health insurance after age 65, or retirement, without loss of coverage or increase in premium. In some areas of coverage, such as paid-up-at-65 policies and major medical, insurance companies are leading Blue Shield.

5. The doctors of Iowa see this bill as a major beginning toward an ever-expanding Government-controlled health care program leading inevitably to compulsory national health insurance and all its evils.

The examples of positive plans and cooperative efforts and accomplishments in Iowa which I have listed are continuing to grow. Such voluntary methods, in conjunction with already existing State and local agencies, including Federal aid, can and will solve the problems of health care for the aged in Iowa without the intervention of the Federal Government.

We ask that this committee give us reasonable time to perfect these plans and cooperative efforts for the health and well-being of over 2,700,000 Iowans.

Thank you.

The CHAIRMAN. Dr. Irving, we thank you, sir, and Dr. Wichern, for coming to the committee and giving us the thinking of the Iowa State Medical Society. We appreciate your coming from Iowa to the committee for this short period to help.

Mr. Jensen, we want to say we appreciate your accompanying these gentlemen. We know you have a very busy schedule. We appreciate your being here to introduce them.

Mr. JENSEN. Thank you, Mr. Chairman. The CHAIRMAN. Are there any questions? Mr. Mason. I just want to make the statement that this is the third State that is doing constructive work toward solving this problem.

Mr. FORAND. Mr. Chairman.
The CHAIRMAN. Mr. Forand.

Mr. FORAND. Dr. Irving, you have commented on the fact that Iowa was the first State to have the Blue Shield senior-65 plan accepted by the physicians and put into operation.

You did not intend to leave with the committee the impression that all the doctors in Iowa were very heartily in favor of this, did you?

Dr. IRVING. No, I certainly did not, Mr. Forand.

Mr. FORAND. Because I have information here that on a motion to defeat the adoption of the plan, the vote was 43 for defeating it and 56 in favor of it.

Dr. Irving. In the house of delegates, as I recall the figures—and I have to recall them from memory-in adoption of the plan it was a 2-to-1 vote; 66 to 33, sir.

Mr. FORAND. 66 to 33. Dr. IRVING. I believe that is right. Mr. FORAND. I have here 43 to 56. Dr. IRVING. I think that was the vote on reconsideration of the plan.

Mr. FORAND. Whatever it was, there was opposition to it? Dr. IRVING. Yes, there is opposition to the plan. Mr. FORAND. A substantial segment of your organization. Then, I have further information which I received from a doctor in Iowa, who does not want his name published, of course, because he says, “One would certainly be crucified if his name were to become known,” indicating that sanctions would be used against him.

However, he goes on further to say that: If only seven men had changed their minds, there would have been no senior 65 and no Iowa Blue Shield. The only thing which held it together even then was the totalitarian way in which the executive committee of the Iowa Blue Shield, several of them officers of the Iowa State Medical Society, was bullying this program through and published it in the newspapers statewide before the doctors of the State had even a prayer to say. No, the Soviet at its very best could not have bullied their ideas through any better.

Have you any comments on that?

Dr. IRVING. We have had opposition, Mr. Forand, but I believe as a physician and trying to conduct our manners in the State society, we have done it on a democratic basis. We had this problem before

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